- A healthy 7 month old should be sleeping 12-16 hours total per day.
- Safe Sleep Practices should be used.
- The Baby should be establishing self-soothing habits.
- BEARS is not appropriate to use in this age group.
Noelani's Story
Noelani, a 7-month baby girl is brought to the clinic by her parents who are concerned that she is not sleeping through the night. Dr Sofia Chavez is her regular pediatrician. Noelani is an only child. She lives with her parents who are in their early twenties. They live in a trailer which is close to her maternal grandparents' house.
Noelani’s parents report that she is not sleeping through the night. They are exhausted. She takes 5 short (1 hour) naps during the day. Noelani continues to breastfeed. She has started eating rice cereal in the morning.
Developmental History: Noelani sits by herself with minimal support, she babbles and is making repetitive sounds, cries only if she is hungry or sleepy, reaches for toys and tries to manipulate them, rolls, has a social smile and recognizes parents.
Expert Insights
BEARS Screening for Noelani
Noelani’s age is below what is recommended for the BEARS screening tool.
Bedtime Problems
Not Applicable.
Excessive Daytime Sleepiness
Not Applicable.
Awakenings
Not Applicable.
Regularity & Duration
Not Applicable.
Sleep-Disordered Breathing / Snoring
Not Applicable.
Noelani's Evaluation & Diagnosis
What evaluation & diagnostic protocol should the medical provider use to diagnose Noelani’s nighttime behaviors?
Check all that apply:
The evaluation and diagnostic protocol recommend for Noelani is:
- Determine elements of the child’s sleep history
- Perform a physical exam
- Safe Sleep Practices
- Feeding Habits
The history of a patient’s sleep problem is always of critical importance. This information helps to guide the physical exam, the ordering of further testing and/or referral to a specialist or reassurance.
Determine elements of Noelani's sleep history
| Sleep History | Case Specific Questions | Noelani's Evaluation Results |
|---|---|---|
What the child does at night |
How long is Noelani sleeping at night? Why is she waking up?
|
Noelani goes to bed each night around 7:00 PM. She finishes breastfeeding 20 minutes before being put down in her crib. Noelani has never slept through the night. She wakes up 1-2 times a night to breastfeed.
|
Review timing of events at night (bedtime/waketime) |
Is Noelani taking naps during the day? |
She takes 2-3 naps during the day that last about 1-1.5 hours each. |
Screen for other sleep issues (OSA, restless leg syndrome) |
Is Noelani snoring or pausing in her breathing while sleeping? |
No. |
Review of medications (antidepressants, seizure medications, and antihistamines all have impacts on sleep) |
What medications is Noelani taking? |
Multivitamin drop, 1 mL by mouth daily. |
Assess for family history of sleep disorders |
|
N/A |
Perform a Physical Exam
| Information to obtain includes: | Case Evaluation Results |
|---|---|
Growth parameters and physical exam, Weight is 15-50% (WHO Child Growth Standards) |
Weight: 7 kg, 50th percentile |
Safe Sleep Practices
| Information to obtain includes: | Case Evaluation Results |
|---|---|
In what position is Noelani place in her crib? What bedding is used? Is her crib the only place she sleeps? |
Noelani is placed on her back when she is being put down for a nap or at bedtime. There is a snug fitted sheet on the mattress. There are no bumper pads, loose bedding, or stuffed animals in the crib when she sleeps. Noelani’s parents purchased a new crib that meets all current safety recommendations. It is set up in a nursery adjacent to the parent’s bedroom. When Noelani is placed in her crib for the night, she cries until her parents take her to their bed. |
Feeding Habits
| Information to obtain includes: | Case Evaluation Results |
|---|---|
What are Noelani's feeding habits? |
Noelani breastfeeds for 20 minutes every 4-6 hours. She is also eating a few spoonfuls of rice cereal, or pureed baby foods a 2-3 times a day. |
Options that are Not Recommended
Order Labs/Other Diagnostic Tests
Noelani’s development, growth, and physical exam are normal. No further testing is needed at this time.
Complete a Sleep Diary
Not applicable at this time.
Sleep Study
Sleep study is not indicated. A history of snoring, cyanosis, or apnea are common indications for a sleep study
Refer to a Specialist
Not indicated.
Red Flags
- Enlarged head circumference, waking up in the middle of the night vomiting or inconsolable crying may be indicators of hydrocephalus and need further evaluation.
- Overfeeding may lead to abdominal discomfort and disrupt sleep.
- Loud snoring or apneic events need further evaluation.
When evaluating a child,
consider how other health care providers may also need to be involved.
Evaluation & Diagnosis
Are Noelani’s sleep habits within normal ranges?
What other factors might be contributing to her not yet sleeping through the night?
Check all that apply:
Noelani’s signs and symptoms are:
- Normal for her age.
Noelani’s signs and symptoms are slightly above average but still within normal ranges. Most infants sleep through the night by 6 months but the range can be 3 - 12 months.
Noelani should be placed back into her own crib after she is attended to upon awakening in the night. Bed sharing is not recommended.
Noelani's Treatment & Referrals
Now it’s time to recommend treatment options for Noelani.
Check all that apply:
The following treatment strategies are recommended for Noelani:
- Placement and use of crib
- Parents offer of comfort
- Feeding habits
- Strategies for infant self comforting
Treatment Strategies for Self Comforting
- Move Noelani’s crib into her parent’s bedroom and put her to sleep in it.
- When she cries, Noelani’s parents should offer gentle comfort and place her back in her crib.
- Increase soft food intake adding a feeding one hour before regular bedtime.
- Provide a pacifier for Noelani during the night.